Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients
IntroductionHypoxic liver injury (HLI) and Killip classification are poor prognostic factors in patients with ST-segment elevation myocardial infarction (STEMI). This study investigates the interrelationship between hypoxic liver injury (HLI) and Killip classification.Method and resultsA total of 1,...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1396243/full |
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| author | Seong Huan Choi Ji-Hun Jang Dae-Young Kim Young Ju Suh Yong-Soo Baek Sung-Hee Shin Seong-Ill Woo Dae-Hyeok Kim Jeonggeun Moon Jon Suh WoongChol Kang Sang-Don Park Sung Woo Kwon |
| author_facet | Seong Huan Choi Ji-Hun Jang Dae-Young Kim Young Ju Suh Yong-Soo Baek Sung-Hee Shin Seong-Ill Woo Dae-Hyeok Kim Jeonggeun Moon Jon Suh WoongChol Kang Sang-Don Park Sung Woo Kwon |
| author_sort | Seong Huan Choi |
| collection | DOAJ |
| description | IntroductionHypoxic liver injury (HLI) and Killip classification are poor prognostic factors in patients with ST-segment elevation myocardial infarction (STEMI). This study investigates the interrelationship between hypoxic liver injury (HLI) and Killip classification.Method and resultsA total of 1,537 STEMI patients who underwent percutaneous coronary intervention (PCI) from 2007 to 2014 at four tertiary hospitals in the Incheon-Bucheon province were enrolled in this study. The patients were divided into four groups based on their Killip classification at presentation in the emergency room (ER). HLI was defined as a ≥2-fold increase in serum aspartate transaminase (AST). The incidence of HLI showed incremental tendency with respect to the Killip classification (19.5%, 19.4%, 34.6%, and 37.8%, respectively; p < 0.001). Left ventricular ejection fraction (LVEF) was below 45% in symptomatic, overt heart failure patients (Killip class II, III, and IV). Both initial and peak AST levels increased in accordance with Killip classification along with cardiac biomarkers. In-hospital mortality was directly related to Killip classification (2.3%, 7.3%, 16.3%, 29.2%) with statistical significance. Univariate and multivariate Cox regression analysis showed that the presence of HLI and combined Killip classification III and IV were poor prognostic factors, even after adjusting for conventional clinical risk factors. Receiver operating characteristic (ROC) analysis showed that combination of HLI and Killip classification was the most sensitive predictor of mortality (AUC 0.832, 95% CI 0.78–0.882). Kaplan–Meier curve showed that patients with HLI and Killip class (III and IV) had the lowest event-free survival regarding in-hospital mortality and major cardiovascular and cerebrovascular events.ConclusionsThe presence of HLI and Killip classification were directly related to worse prognosis in STEMI patients. Early recognition of HLI and accurate assessment of Killip classification is warranted for effective management of STEMI. |
| format | Article |
| id | doaj-art-308b2a1eb36b48b0ae2e0865638706b7 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-308b2a1eb36b48b0ae2e0865638706b72025-01-20T07:20:26ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.13962431396243Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patientsSeong Huan Choi0Ji-Hun Jang1Dae-Young Kim2Young Ju Suh3Yong-Soo Baek4Sung-Hee Shin5Seong-Ill Woo6Dae-Hyeok Kim7Jeonggeun Moon8Jon Suh9WoongChol Kang10Sang-Don Park11Sung Woo Kwon12Department of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of KoreaDepartment of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of KoreaDepartment of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaDepartment of Cardiology, Inha University Hospital, Incheon, Republic of KoreaIntroductionHypoxic liver injury (HLI) and Killip classification are poor prognostic factors in patients with ST-segment elevation myocardial infarction (STEMI). This study investigates the interrelationship between hypoxic liver injury (HLI) and Killip classification.Method and resultsA total of 1,537 STEMI patients who underwent percutaneous coronary intervention (PCI) from 2007 to 2014 at four tertiary hospitals in the Incheon-Bucheon province were enrolled in this study. The patients were divided into four groups based on their Killip classification at presentation in the emergency room (ER). HLI was defined as a ≥2-fold increase in serum aspartate transaminase (AST). The incidence of HLI showed incremental tendency with respect to the Killip classification (19.5%, 19.4%, 34.6%, and 37.8%, respectively; p < 0.001). Left ventricular ejection fraction (LVEF) was below 45% in symptomatic, overt heart failure patients (Killip class II, III, and IV). Both initial and peak AST levels increased in accordance with Killip classification along with cardiac biomarkers. In-hospital mortality was directly related to Killip classification (2.3%, 7.3%, 16.3%, 29.2%) with statistical significance. Univariate and multivariate Cox regression analysis showed that the presence of HLI and combined Killip classification III and IV were poor prognostic factors, even after adjusting for conventional clinical risk factors. Receiver operating characteristic (ROC) analysis showed that combination of HLI and Killip classification was the most sensitive predictor of mortality (AUC 0.832, 95% CI 0.78–0.882). Kaplan–Meier curve showed that patients with HLI and Killip class (III and IV) had the lowest event-free survival regarding in-hospital mortality and major cardiovascular and cerebrovascular events.ConclusionsThe presence of HLI and Killip classification were directly related to worse prognosis in STEMI patients. Early recognition of HLI and accurate assessment of Killip classification is warranted for effective management of STEMI.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1396243/fullSTEMIHLIKillip classificationPCIpercutaneous coronary interventionall-cause mortality |
| spellingShingle | Seong Huan Choi Ji-Hun Jang Dae-Young Kim Young Ju Suh Yong-Soo Baek Sung-Hee Shin Seong-Ill Woo Dae-Hyeok Kim Jeonggeun Moon Jon Suh WoongChol Kang Sang-Don Park Sung Woo Kwon Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients Frontiers in Cardiovascular Medicine STEMI HLI Killip classification PCI percutaneous coronary intervention all-cause mortality |
| title | Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients |
| title_full | Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients |
| title_fullStr | Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients |
| title_full_unstemmed | Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients |
| title_short | Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients |
| title_sort | interrelation between hypoxic liver injury and killip classification in st segment elevation myocardial infarction patients |
| topic | STEMI HLI Killip classification PCI percutaneous coronary intervention all-cause mortality |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1396243/full |
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